23A MARION RD - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? if dwelling, how many unds?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name d C--,(7,,
Address and Phone e
Construction Supervisors License# HIC Registration#
Estimated Cost of Project S m Permit Fee CftWftn
Project
Permit Fee$ Estimated Cost X$7I111000 Residential
Estimated Cost X$11/i1000 Commercial -
An Additional $5.00 is added as an
Administrable charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to to the above s led
specifications. Signed under penalty of perjury X
Date
of N
N
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— EITY-OFS r— —
PUBLIC PROPERTY
DEPART IME,INT
I:I�YfFJLEY D�15L'lril
MAYOR 12D WAaualc.-M*b'MEEr Wit{.MAssAGHtStTR 01970
1419711-74S-9S" 1 PAX 976740.9g"
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: ( G/ Building:
Property Address: �_ /I�e✓p� l cr1
Property Is located in a; Conservation Area Yftk- Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building 1 New
Bciet Description of Proposed Work:
Mail Permit to: c i 2Q